Immunosenescence and Immunosuppressive Drugs in the Elderly

Abstract

The majority of patients awaiting or receiving solid organ transplantation are older than 50 years. The implications of immunosenescence are broad since the elderly transplant recipient is characterized by higher rates of diabetes, infections, and malignancies, which represent major causes of death. Indeed, those changes are linked to the applied immunosuppressive drugs and may indicate an age-adapted immunosuppression. For instance, corticosteroids, calcineurin inhibitors, and mToR inhibitors are related to new-onset diabetes. On the other hand, acute rejection rates are less frequent in older recipients, whereas the engraftment of older organs is linked to higher rejection rates. Another complicating factor is age-related physiologic changes resulting in altered pharmacokinetics of the immunosuppressive agents. Therefore, age-adapted induction and maintenance therapies must address the impact of immunosenescence and altered pharmacokinetic profiles when appropriately managing elderly transplant recipients. A selective application of immunosuppressive protocols, in addition to proper dose adjustments, may allow a more tailored treatment of older organ transplant recipients.